The DIPS story - a Long and Winding Road

Transcription

1 The DIPS story - a Long and Winding Road Tor Arne Viksjø CEO Telefon: [email protected] DIPS ASA Jernbaneveien 85 Bodø Telefon:

2 My agenda The DIPS story What happened? Where are we today? Where do we go on? Please do ask questions!

3 The story about DIPS

4 1982

5 Hospital-IT in the 80 s Characterized by large, expensive and proprietary computer systems IBM, Datapoint, Norwegian Data, Data General +++ Hospitals used ØMI (Economic Medical information system), later AMI, run on Data Central Departments registered ØMI forms Information about admissions and diagnoses were punched on floppy disks Then driven by truck to local data central In return trucks carrying reports of very variable quality! But the basis for the revenue to the hospital

6 The work routines for physicians, nurses etc. Post Cabinet Information System A lot of walking for the employees Lab orders to be delivered at 0400 latest Lab results produced during the day were delivered in the cabinet Referrals put in the cabinet for the physician Paper records were written on typewriters with numbered pages Very work consuming!

7 1985: Choosing Computer System as NSS The IT Committee decided that an online computer system was needed Many visits to larger hospitals in Sweden and Norway A pilot using Datapointequipment and software developed by ScanvestRing was tested in 1986 Handling admissions, transfers and discharges, and diagnoses/procedures could be registered. Early 1987, the hospital decided not to continue the use of the Datapoint system Primary reason was lack of market impact for this system

8 The development of DIPS in 1987 All systems available were proprietary hardware/software running on expensive large/mini computers On the other hand PC s with high capacity were available at a low cost Novell Netware Network system was available and working well Development software was available Why not develop a new system on PC/Network?

9 DIPS Development One more software engineer employed We were using Dataflex with database files During some busy months we produced software to replace the Datapoint system Coax cables were distributed to all offices, wards and reception PC s (cheap ones) were bought and distributed We used Novell Netware 386A server with dual disks and controllers (2 x 186 MB) with RAID On the 18 th of September 1987, DIPS was put into use and it worked! Distributed Information Patient System

10 New modules developed EHR was developed integrated with the PAS LAB and RIS systems were developed News about DIPS spread Several new hospitals signed agreement to use DIPS A kind of joint venture sharing development cost

11 The years EEA/EU-agreement went into force in 1994 Requiring the hospitals to invite tenders The joint venture cooperation around DIPS was not the future High demands were waiting, DIPS for Windows in development We struggled with a Y2K bug! DIPS became a private limited company in 1987 Owned by the employees (51%) and the old customers (49%)

12 2002 The first workflow system Integrated scanning (bulk and single) The first Paperless Hospital in Norway Arendal Sykehus Relevant parts of the paper records were scanned into the DIPS EHR And shredded! Physicians started with our electronical workflow system The paper based records went out of use

13 The benefits and effects The Patient Records available in the whole hospital at once Quicker response to patient requests Quicker and easier clerical routines Writing queues gone, lesser stress Some physician work easier, some heavier The clerical staff ran less and gained weight, 3-5 kg

14 Before DIPS They had 6 of those shelfes, several months queue

15 After DIPS No writing queue! Dictation Tapes not needed!

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17 But did the physicians use the EHR System? Research work at NTNU Questionnaire developed by dr. med. Halvard Lærum 23 important work tasks Supplied with interviews

18 Lærum et al 2006: DIPS at Arendal

19 Lærumet al 2006: Hospitals not using DIPS

20 The Norwegian Hospital Reform

21 2003: The The Norwegian Hospital Reform From 74 hospital customers to 5 very large Health trusts The Eastern Regional Health Authority was the first to announce a tender Very exciting and scary for us! Would the large ( employees, 60 MrdNOK) trust put the responsibility for the core PAS and EHR system into the hands of the small DIPS Company (30 employees)? Not very good odds, we were the underdogs in this competition! We made an strategic alliance with Deloitte Consulting Bids came from WM-data, Tietoenator and Siemens DIPS, Tietoenator and Siemens in the final round

22 2003 bid for Eastern Regional Health Authority A lot of requirements (2300) Demonstrations for a large group of clinicians We made a good impression And won the tender! Probably the most important contract for DIPS ever The start of a very important period of deliveries of DIPS

23 How did we deliver? As a part of the contract, every hospital went through a preproject planning and estimating the main project We (Deloitte and DIPS) made a thorough study of the work routines How could these routines be more efficient and leaner with DIPS? Flowcharts were made and studied New routines were written and put into a large education program

24 From the Paper Based Record world

25 Et eksempel fra DIPS Digital EPJ

26 Our delivery projects were successful We went through a many large delivery projects Old databases with EPH and PAS information were converted into the DIPS Database Integration with 3 rd party systems were produced DIPS was put into servers and clients Using Oracle high availability software (Real Application Clusters + Dataguard) Usually the old system was put into read only Thursday, data was extracted and converted and tested Sunday, and DIPS went live on Monday

27 Todays Company

28 Technology success from North Norway The largest EHR/PAS vendor in Norway 200 employees later this year Outsourcing (Belarus) Revenue 250 MNOK Main office in Bodø Offices in Tromsø, Trondheim and Oslo

29 Owned by the employees 8 % 11 % 62 % 19 % Vest Agder County Diakonhjemmet Hospital Nordland County Employees

30 DIPS and research We contribute in several projects, both with financing and active participating Prosject Owner Participants Theme Tromsø Telemedicine Lab Many Prosess-support SINTEF DIPS,University Hospital of North Norway TheInnlandet Health Trust National Knowledge Center/NTNU/DIPS Halogen Sintef, Linköpings Universitet, Hafslund Strøm, Finn, DIPS ACTIV Project, optimization EVICARE:«Evidence-Based Medicine» (EBM) at the point of care, integrated with an electronic health record (EHR) To develop a visual language for service design

31 Todays Market Situation Region Mid-Norway Oslo University Hospital

32 Norway and penetration of EHR Almost complete

33 Norway does not have a common EHR A very restricting legal framework EHR only available within each legal entity Message based communication since early 90 s Lab/X-ray results Discharge notes Referrals Electronic Prescriptions for the Patient is rolling out Message based communication with the elderly care/nursing homes

34 Healthcare Challenges We are getting older and older, and the elderly getting sicker The growth in healthcare to be able to handle the future needs the next ten years is scary We must focus on preventing diseases instead of repairing Obesity is becoming a major health issue

35 EHR challenges Most physicians still use the dictation machine It is always very challenging to change work routines But very necessary to get benefits All implementations are large projects for organizational development The patient must still repeat a lot in her journey through the health care system Many specialist systems live within their silos Many physicians wants better interfaces, more functionallity, more process support etc.etc. How can we address these needs?

36 DIPS Arena Our next generation EHR

37 Our newehr: DIPS Arena In 2006, we started rebuilding our EHR/PAS on SOA Building on the knowledge from 25 years of development in Norway Developed in close collaboration with our customers Workgroups with clinicians from all customers Monthly reviews of new functionality This year we are piloting the first parts of DIPS Arena

38 Wemust do it smart DIPS Arena will not be a copy of DIPS Classic We try to think smart and find better ways to handle the needs and requirements Making it a better solution for clinicians Better overview Process support Decision support through guidelines The capacity to develop (and maintain) software is limited At the same time the requirements and complexity is growing We must find more sustainable ways of developing DIPS One initiative is to do Model Driven Engineering

39 Model Driven Engineering (MDE) In order to do MDE we searched for a domain model We had great belief in the archetype concept EN ISO standard presented archetypes for healthcare Had a reference model and clinical information represented in archetypes These concepts were taken further by the OpenEHR initiative Developing open source software and information models

40 We have committed to the OpenEHR platform Using both theopenehrreference modeland thearchetype formalism Not for the purpose of standardization, but as a tool for «Modell driven development» We have adapted specialized component types (Observation, Evaluation, Instruction and Action) Dividing our development into a core part and a MDE part

41 Model driven development Users Variables, archetypes and terminology Templates Process templates and clinical pathways Authorization templates and mandates Instanciate and use Domain experts modellerer Date content User Interface Work processes Security Model driven Creator A stable /well defined core Services and interfaces Referencemodels Standards Database schemas OpenEHR Two-level Modelling Core development Team

42 Towards more structure Today, most of the EHR is unstructured, free text And it is repeated many times Can we give the clinicians a flexible and easy to use tool for structuring more of the EHR? Using floating archetypes and autocomplete? Can we enable parts of the EHR to be persistent?

43 StructuringtheEHR is not an easytask In Denmark, the G-EHR project (2002) Every single observation, plan and result was to be registred structured based on Snomed-CT nomenclature This initiative was cancelled in 2007 Many reasons, one major was the increased workload

44 How does DIPS Arena look like?

45 Example: Better overview for physicians

46 Example: Using structure/archetypes

47 Example: Enterprise Search How do we enable search as a technology, without loosing patient information security? Can a word cloud based on medical key words in documents be useful? We can use MeSH(Medical Subject Headings) as tags To be usable, search must be immediate We implemented Apache SolRas an open source enterprise search platform This gave necessary speed, both for word clouds and free text search in the EHR

48 Example: Word clouds

49 Better decision support Evicare: Research study: How can we integrate evidence based knowledge into the EHR? Establish link between structure (problem/ diagnosis) and guidelines GRADE is an initiative to establish a common, sensible and transparent approach to grading quality of evidence and strength of recommendations MAGIC provide guideline organizations with digital tools so that they can develop, adapters, publish and update reliable guidelines based on the GRADE system. We integrate MAGIC into the DIPS Arena (Interested? Contact Linn Brandt, [email protected])

50 Integrating MAGIC

51 Integrating clinical guidelines

52 Why did we succeed?

53 Why did we succeed? All we did was bottom up In close cooperation with the users Picking low hanging fruit, one at a time We were able to build trust from the customers Many of our employees have clinical background (nurses, lab technicians, a few physicians) Our employees find it encouraging to make software for a better healthcare

54 Why did we succeed? We are very proud over our achievements these 25 years Probably the best explanation is a lot of stubborn long time commitment It is tempting to cite Churchill Continuous effort, not strength or intelligence, is the key to unlocking our potential

55 Thank you! Tor Arne Viksjø CEO Telefon: DIPS ASA Jernbaneveien 85 Bodø Telefon: